Sunday, September 27, 2015

Week 44: Ultrasounds, chocolate and happiness

I spent the first part of Monday organizing where I'd even be the rest of the week. 

Originally planned was that I would start in the pneumology department. This is a rather small department to start with and they still had an intern planned to be there for the next two weeks. One intern is almost an overdose, so two would have been overkill. I ran between various secretary offices and making calls to the chief of the department. I saw on the official plan that the gastroeneterology department I had been in the last few weeks and which is the biggest of the four internal medicine departments, didn't have an assigned intern. The chief of the department was ecstatic and told me I was more than welcome to stay in the department another week. After talking it over with the pneumology chief and having it noted by the secretary, I was back in the gastro-department. 

The set up of doctors was a bit different this week. I spent a lot of the time placing i.v. lines and drawing blood again but I also spent a lot of time on rounds with the doctors. The two doctors I went with were great! They asked me a bunch of questions. Some I could answer really well, others not so much but they were great at explaining the answer to me and helping me understand why things are as they are. I had some mind blowing moments there. Little things that I just learned during my studies but never really understood why were explained to me. 

Smaller wasn't an option?
I quite enjoy rounds where I'm asked a lot. I don't expect myself to know everything but it gets my brain working and is practice for my exam. The annoying this is when the brain doesn't work. I was asked by which system liver cirrhosis is classified. I definitely knew I knew the answer but all type of other scores started popping into my head and blocking my thought of the right answer. After a few moments I had it but that just felt annoying because I don't want that happening during my exam.

I went on grand rounds as well. Since I had had an informative day of rounds the day before, I was hoping I could shine because the chief would ask about the same questions. Oh how naive Ms. H. (Miss H Dot is what chief calls me, although he actually knows my name). He ended up asking questions that luckily the resident couldn't answer in it entirety either. Its just how chief is. He asserts his superiority with it. That's fine because I end up learning something as well. 

The one doctor took me along to do ultrasound this past week. Instead of him doing it and telling me something, he immediately had me sit down and do it. I'm rather good at finding the kidneys and bladder due to my urology rotation but for the rest of the abdomen, I didn't have a clear system. It ended up being a lot easier than I had imagined it would be. He showed me how to find all the things I needed to look at. Of course, each patient is different and some are easier to examine than others but I definitely feel more confident in examining many parts of the abdomen. 

I watched a few colonoscopies throughout the week. It really is a super important exam everyone over 50 should have. If you fall into that group and haven't had one. Go get it done. Its not a big deal and you're thinking about way to much in your head and worrying about things.....its not a big deal. But it can be a big deal if it helps find something that can be removed.

There were so many sweets on the ward this week. I really tried to hold back most of the time but sometimes it took so long for everyone to be ready for lunch that I just had to chow down a bit. I need to make sure to take more healthy snacks with me in the future so that I'm not as tempted. 

Tuesday evening, I went to see Ali and his family and give them the money I was able to collect. Thank you from the very bottom of my heart to every single person that donated. I can't express how happy it makes me feel inside that there are such nice, helpful people out there. Being able to help Ali and his family is one of my proudest accomplishments and those who donated or donated their time to help me are a part of that happiness. So thank you!

This coming week, I'm only at work for 2 days before heading to Santorini with some members of my family! WOOHOO! I can NOT wait! I've wanted to go to Santorini for the longest time. I hope to have a relaxing week that will get me ready to get down and dirty and study for my practical exam!

Have a good week! Stay healthy!


Sunday, September 20, 2015

Week 43: Oh the redundancy......

I'm coming off of couple of very sleep deprived days.....for a change, this time medical school was not the culprit.

The work week was rather redundant. I spent most of the days drawing blood and placing a series of i.v. lines every day. It has gotten to the point were I almost enjoy placing i.v. lines. I've been so successful that I see every new line as an opportunity to keep my stats up and take on challenges to push my abilities. 

"Hey Viktoria, want to place another i.v. line for me?" my facial response. Pure excitement

There were so many to do though that I didn't even attend rounds the first few days! Except Tuesday for grand rounds. Chief asked a lot of questions again and I was more graceful with my answers than last week. I even low key impressed him when I answered a question. He told me that most gastroenterologists didn't even know that answer....which again surprised me because you could easily answer it if you knew the blood vessel anatomy of the stomach and spleen (which I guess I assumed most doctors did). 

I admitted another patient. She was an elderly lady and the conversation went much longer than it needed to be. We ventured off into none medical topics as well. I think the two years I spent living with my grandparents and spending so much time with my grandma and her friends really influenced me. The idea of a big round of older ladies, coffee and cake sounds great to me....I'm guessing that's not the case for most 25-year-olds. 

Giving your intern ample amounts of chocolate for her help is most definitely appropriate

Since it was my last week in the gastroenterology department, I really wanted to make sure I get to see some endoscopy procedures. 

I watched an ESD (endoscopic submucosal dissection). It is a procedure in which, for example, neoplasms (new formation of tissue that shouldn't be there and could possibly be cancerous) in the colon are removed. Older procedures would use a type of electrical sling to remove that growth but the reappearance rate is high. With the ESD, the layer between the mucous membrane and the muscle layer is cut apart and if done correctly, practically  diminishes the recurrence of new formations at that location. This procedure can take anywhere from 2-10 hours according to the chief. Its basically an operation an internist performs. 

Oh hey there BFF Coffee......what a surprise to see you here!

I also was shown an ERCP (endoscopic retrograd cholangiopancreatography). Essentially, you go through the mouth, through the oesophagus into the stomach and on to the small intestine. There you'll find the opening from which the pancreas and gallbladder excrete their fluids. The passage ways of the bile and pancreas can be displayed using contrast medium. This is good to see where strictures or obstructions in the passage ways might be. The doctor also performed a 360° ultrasound of the upper gastrointestinal tract which was interesting to see and not so easy to interpret.

Besides that, I spent my time with the patients and their terrible veins. 

Thursday, I left for Berlin after work to meet up with friends that were on tour in Germany and hung out with them for a few days, watched the shows and just had a great time getting away from it all.
The Badder

DJ Premier and the Badder

Posers. Practice. Preemo.

Tomorrow, snap back to reality, Oh there goes gravity.......ok I'll stop there ;)

Stay healthy my friends!


Sunday, September 13, 2015

Week 42: The chill life of thoracic surgery and my little man Ali!

That was easier than I thought it would be.

The past week was less stressful than I expected it to be. Not because I'm some sort of natural at being a doctor but rather because the work load I had anticipated didn't exist. 
The chief, the attending and I did almost everything together. Sure, I got to change the bandages and remove chest tubes and suture at the end of surgery, but this wasn't anything I hadn't really done before. The only difference really was that I wrote a few release notes and my computer access was upgraded to full access of a doctor instead of my limited intern access. A lot of time was spent in the chief's office drinking coffee and eating snacks.

It was fun being back in the surgery department for a week. I all of a sudden saw a lot more of my surgical colleagues than before (the internal medicine department is on a different level of the building so at most I would see the surgeons in the hallway or at lunch but due to politics, you ate with your department). My time in internal medicine did shine a bit through while writing the first release letter. 

Surgical release letters are quite straight forward and to the point with little story telling involved. Patient had this. We did that. He left in a good condition.

Internal medicine release letters are some what of a novel about the patients life. It includes a long history of the patient, all the ailments he has, all the medications they are on, all the diagnostic tests that were run and the interpretation of them, how the treatment will go on from here.....they are easily 5-7 pages long compared to the usual 2 in surgery. 

So when I was working on the first release letter for my thoracic surgery patient, I started with a good thorough history of all the doctors the patient had already been to and had lead them to us. Continued with all the x-rays we had done and the interpretation of each. And filled the rest of the slots with ample information. When the attending came to look over the letter with me, he deleted about 2/3 of the text. From that letter on, my letters were short and to the point. 

We operated Tuesday through Thursday and had 4 operations. Removed a segment of a lung, a small part of a lung, took samples of a lung with a lot of adhesions and removed a lipoma on a mans chest. Most of them went as planned and only took 2-3 hours. The one that really got me was the patient with the adhesions. 

It was on Wednesday that we had two operations. The first one wasn't a problem and even finished a smidge earlier than expected. The second one was only supposed to be taking a sample from the pleura (the tissue covering the inside of the chest and the lung) since it looked thick in the CT scan and the patient had a history of working with asbestos (needed to see if that was a mesothelioma (I'm sure you've heard the commercials on TV about asbestos and mesothelioma and how you should hire their lawyer to get money)). The operation was expected to take 1.5 hours. It was already hard enough gaining access to the inside of the chest due to the adhesions but once we had an opening, we saw just how stuck together everything was. The surgeon just sighed and said this would take a bit longer. I sighed in my head because that day was technically a day I could go home an hour early and I had a massive to-do list I needed to get stuff worked off of). About an hour after that realization the anesthesiologist asked how long we anticipated the surgery to last and the surgeon replied, "easily 2-3 more hours". Great. We luckily all requested chairs to sit on because my back was already making itself noticed an hour into the surgery. I waited until 2.5 hours into it to ask for a chair though. Luckily the staff was friendly and we chatted a bit during the operation because all I did was hold hooks and was hardly to actually see anything in the chest. Not the most exciting thing to do. Chief came in the OR and told me he was going to go do the seminar with the interns and then come back in time so that I could catch the 5:25PM train with the other interns. He said he wanted to be in the OR by 4:40 since I had to leave the hospital by 5 if I wanted to catch the train. He didn't show up until 4:55 and we were basically done just doing the last suture. I hurried off to get changed and grab my stuff and left to catch my train. 

The week was fun and relaxed and the chief is still trying to convince me to start in the department. If I really did, I know it would be a rather relaxed job. The surgeries might kill my back but all in all, it would be a chill work environment. To bad my dream isn't becoming a thoracic surgeon.

Remember Ali? The little boy from Azerbaijan I told you about? He had his check up ultrasound this week and everything looks good! I started a little donation collection to help the family out. Below is the letter I sent out to family and friends asking for even just a little support to help this little family out. If you have $5 or however much to spare, I'd greatly appreciate it if you participated and I know the family will be so thankful as well!


Dear  Friends & Family,    

I’ll  try  to  keep  this  short  since  I  know  you  are  all  busy  people.  A  few  months ago,  I  was  introduced  to  little  2.5  year  old  Ali  from  Azerbaijan.  His  father worked  really  hard  to  get  a  scholarship  to  study  in  Germany.  One  of  his  biggest motivations  was  to  get  better  medical  care  for  his  son.  Ali  was  diagnosed  with hydronephrosis  in  his  home  country.  This  refers  to  distension  and  dilation  of  the kidney  pelvis  and  if  left  untreated  could  lead  to  kidney  failure.  For  Ali,  this  meant many  painful  days  of  kidney  pain  and  for  his  parents  a  lot  of  frustration  not being  able  to  help  him.  
Through  many  fortunate  coincidences,  I  was  introduced  to  him  and  his  family while  working  in  the  urology  department  for  my  internship  year.  The  doctors  took a  look  at  him  and  his  files  and  referred  me  to  the  pediatric  surgeon.  This  surgeon was  nice  enough  to  meet  with  me  and  explain  possible  treatment  options  for  Ali. We  were  perhaps  looking  at  a  $13,000  operation  bill  that  I  would  have  started fundraising  for.  I  organized  for  Ali  to  have  an  examination  done  that  would determine  if  he  needed  surgery  or  not  and  covered  the  costs  for  the  family  with some  help  from  my  grandma.  Although  his  hydronephrosis  was  rather  advanced,  as if  by  a  miracle,  he  had  grown  out  of  it!  That  isn’t  unheard  of  but  we  weren’t expecting  it  due  to  how  advanced  it  was  a  few  months  ago.  So  yay!  No  surgery needed!  The  surgeon  offered  to  give  Ali  a  check  up  before  returning  home  to Azerbaijan  in  September  2015.  

In  the  end,  it  couldn’t  have  turned  out  better  and  Ali  looks  much  healthier  than he did  when  I  first  met  him.  However,  the  family  went  through  great  trouble  to  get him  better  medical  help.  They  took  up  credits  in  Azerbaijan  to  pay  for  the  flight to  Germany  and  had  many  other  expenses  to  make  the  trip  happen.  They  came  to Germany  not  speaking  a  word  of  German  and  into  a  culture  completely  different than  their  own  in  order  to  get  the  best  help  they  could  for  Ali.  They’ve  been nothing  but  kind,  welcoming  and  modest.  I  would  like  to  help  the  family  pay  off some  of  their  debt.  This  is  where  I  need  your  help.  I’m  asking  you  to  donate what  you’d  like  (I’d  be  thrilled  even  if  its  $5)  to  help  this  great  little  family.  

I  tried  to  think  of  ways  to  make  it  easiest  for  you  to  donate.  Below  you  can  find my  paypal  account  and  bank  account.  If  you  are  so  kind  and  donate,  please  put Ali  as  the  subject.  September  18th,  I  will  draw  all  the  money  donated  from  the accounts  and  give  it  to  the  family.        

We  often  take  our  good  life  circumstances  for  granted  and  its  
situations  like  these  that  make  me  grateful  for  what  I  have  and  motivate  me  to help  others  less  fortunate.  I  thank  you  in  advance  for  your  humanity  and donations!  

Stay  healthy,    

Bank  Account: ApoBank     Viktoria  Hasselhof   
IBAN:  DE87  3006  0601  0008  8322  85 


Thank you to everyone who helps out!

Next week I'm back in Gastroenterology for a week. So it's back to long rounds and even longer release letters!

Stay healthy!


Monday, September 7, 2015

Week 41: And the award for best supporting beverage goes to..........COFFEE!

If I ever win an award, I will be sure to thank caffeine for existing. This past week, caffeine was my superhero. 

Award for best supporting beverage: Coffee

Caffeine, aside from the one or other fine wine or Hennessy will be the most extreme I will ever get with any type of drug. I try to ween myself off of coffee and for very long periods of time, I don't need a coffee during the day. I even sometimes have phases were I can't drink coffee because the thought alone disgusts me. Other times, and the phase I'm currently in, is that I enjoy drinking a coffee in the morning and sometimes during the day. 

This past week, it kept me alive.

After getting home late Sunday night from visiting my grandma in the hospital again, I went to work Monday. Since it was a usually Monday, a coffee was needed just for that. After the morning rounds, I spent the rest of my day dealing with blood draws and placing about 8 lines. I lost track at some point. When a patient needs a new line, the nurses don't tell me, they simple place a bandage that is used to keep the lines in place on the counter. This inefficient method requires me to look into the supply room every now and then to see if there is something for me to get done. It started off with 3 bandages. When I was done successfully placing those, I walked into the supply room in order to put away the things I had used only to find 3 more bandages waiting on me. Once those were through, I found two more. The residents even felt bad for me and told me to just leave some for the others if need be. I can't live with leaving things behind for others to pick up, especially when it is more or less technically my task to complete. After all of those, I went to the tumor board conference. I had warned the doctors that I wouldn't be coming the next day because I had to go to my grandmas again. I had originally planned to take Friday off but now had to switch that for Tuesday.
Monday Night: Straight Outta Compton

Tuesday morning, I hopped on multiple trains and arrived at my grandmas 3.5 hours later. After a bit of a fiasco on the weekend where the nurses didn't want to give me information about my grandmas treatment although they were actually legally obliged to do so, I finally had a nice talk with one of the doctors there. I'll tell you a pretty stupid position to be in: being an almost doctor with a grandma in the hospital and your relatives all wanting you to bud into the doctors's not my place and makes me feel rather uncomfortable. It's not like I'm going to know more than the attending. The nurses and some doctors definitely didn't act right in regards to the situation but I still tried to be respectful of their positions whilst also accomplishing some of my relatives requests. 

Tuesday night, I attended a concert in Hamburg. It was a great time. I hung out with some friends and only got 1.5 hours of sleep before catching my train at 4:50AM back to the hospital in time for work. I got about an hour of terrible sleep on the train. So, with that amount of sleep in me, I looked and probably acted like a zombie all day. I pumped three cups of coffee in me (I'm aware this is still little compared to the hard core addicts). Nonetheless, it just barely got me by. It was another day of placing lines and drawing blood. It was almost the end of the day and time for me to leave for two rounds of seminars when I was asked to admit a privately insured patient. I pushed myself to read through the old release letters before heading to the patient. He was a very nice gentleman and I don't think he perceived me as such a zombie. Afterwards, I quickly headed to the seminars with my third cup of coffee in hand. 
DJ Premier and his live Band in the Mojo Club Hamburg

Where did my drums go??

Breakfast of champions: yogurt and tortilla chips

Once I arrived at the train station to catch the train home, I was beyond excited to be in my bed soon. Unfortunately, I realized when I was on the train (before the train left) that I forgot to buy my monthly ticket. I quickly jumped out of the train again. I went and bought my new ticket and ended up having to wait an hour until the next train came.........greeeeaaaattt. I was too tired to even be mad. I slept like a rock that night.

The eight hours weren't enough however and I needed two coffees on Thursday and Friday to get through the day. Thursday was grand rounds. I was still tired and the chief caught me off guard and I sort of bombed the first round of questions regarding the anatomy of the stomach (something I actually know really well). Luckily, throughout the grand rounds, I redeemed myself nicely and also asked a lot of questions which made him feel good because he could explain things to me. The rest of the day was guessed it, with difficult blood draws and line placing. We had our seminar with the chief that day and I rocked it. The topic was colorectal cancer and for some reason I was a roll. I was answering questions to completion where he could only nod and say that was correct (which is odd for that particular chief).

Friday was much the same like the rest of the other days. During lunch, the chief of thoracic surgery called me and asked if I wanted to drain a pleural effusion. When I asked him "when?" and he said, "now", I quickly ate three more bits and hurried to him. I had drained one pleural effusion before with a bit of help, this time, he let me do everything. 

The patient I had admitted Wednesday, became my patient. This meant I checked on him, looked to make sure his examinations were requested in the computer and wrote his release letter. It was a fairly simple case but a good start to get used to what is in store this coming week. 

Starting Monday, I'll be in the thoracic surgery department for a week as a pseudo-resident. Should be a good and challenging week. 

I spent the weekend in Stuttgart visiting family. I arrived Friday night to a yard filled with 5 screaming kids (under the age of 5). They all thought it would be fun to chase me around. You'd think that would be the last thing I wanted to deal with after the week I had but, I loved it. The rest of the weekend was also relaxing in a crazy family and nature kind of way.

A few of my favorite people

I'm captured.

Out and about near Stuttgart

Let see how many pounds I gain or lose depending on how much I prep myself for operating and how long the operations actually go where I'm not eating most of the day.  

Stay healthy!